Galesville Area Summer Rec
2017 Permission and Registration Form
Family Last Name: ____________________ Parent/Guardian Name(s):______________________
Address: ___________________________________City:___________________Zip:_______
Home Phone: __________________ Work Phone: _______________ Cell: ___________________
Email Address: _____________________________________________________________
Emergency Contact Name: ________________________________________________
Emergency Contact Number: ______________________________________________
Athlete Information: (please use one form for multiple athlete families)
Athlete’s Name
Birth Date
Age
Gender
Grade
Sport(s)
1
2
3
4
5
2016 REGISTRATION FEES
$55.00 per child or $94.00 max per family (prior to 5/3/17)
$75.00 per child or $125.00 max per family (after 5/3/17)
GASR
Mail form and appropriate fee to:
PO Box 53
Galesville
WI 54630
I hereby understand that my son or daughter is registered to participate in the program stated on this sheet,
sponsored by Galesville Area Summer Rec. In addition, I understand that his/her program, like other physical
activity, has some inherent risk involved. Furthermore, my daughter or son is in good physical condition
appropriate for the stated activity, and I understand that participants must assume full responsibility for
injury while taking part in these programs
Parent or Guardian Signature_____________________________________ Date: ___________
Resident of (please check one box):
City of Galesville
Town of Gale
Town of Caledonia
Village of Ettrick
Town of Preston
Village of Trempealeau
OTHER:
Town of Trempealeau
Total Due:
$ ___________
Paid by:
Check #______
Checked out by:
__________
Checks payable to GASR
Cash
Galesville Area Summer Rec.
Code of Conduct
Player Code of Ethics:
Parent Code of Ethics:
• I will remember that winning is important but
learning skills, good sportsmanship and teamwork are
our goals.
• I will encourage good sportsmanship from fellow
players, coaches, officials and parents at every game
and practice. I will be humble in victory and
gracious in defeat.
• I will listen, learn and play to the best of my ability.
I will strive to always give my best effort at every
game and practice. I will take responsibility for my
mistakes and try to learn from them.
• I will treat other players, coaches, parents, fans and
officials with respect regardless of race, sex, creed or
ability and I will expect to be treated the same.
• I will remember that this is a team sport. The team
comes first, ahead of my individual
accomplishments. I will be supportive of my
teammates and helpful to my coaches.
• I will take good care of team equipment, the field
and physical property of the club. I will treat it with
gentle respect. I will put equipment away when I
am done using it.
• I will NEVER throw a bat or anything in anger or
display other signs of a bad temper after
unsatisfactory play or an umpire call that I do not
like.
• I will emphasize to my child that winning is
important but learning skills, sportsmanship and
teamwork are our goals.
• I will remember that when I am wearing a
Galesville uniform that I am representing my team
and my town. I will behave in a respectful, courteous
manner & realize that what I do is a reflection on my
team/town.
• I will respect the decisions of my coach. If I have a
concern or problem with the program I will discuss it
with the coach in private at a non game time.
• I will make every effort to attend every practice &
every game. I will make every effort to be on time. I
will notify the coach if I am unable to attend or be on
time.
• I will give first priority to playing baseball in
Galesville. If I sign up for another team I will
discuss this with the coach in advance & understand
that missing games/practices could influence my
playing time.
• I will encourage good sportsmanship by
demonstrating positive support for all players,
coaches, and officials at every game and practice.
• I will place the well-being of my child ahead of my
own personal desire to win. I will remember that the
game is for the players, not for the parents.
• I will offer encouragement instead of criticism and
praise effort over performance. I will be sure that my
child knows that “it is not whether they won or lost, it
is how they played the game.”
• I will treat other players, coaches, parents, fans and
officials with respect regardless of race, sex, creed or
ability. I will encourage my child to do the same.
• I will encourage my child to be present at every
practice and game and to arrive on time. I will
encourage my child to notify the coach when this is
not possible.
• I will be involved with the Galesville Area Summer
Rec program as a supporter and volunteer to the
extent possible.
• If I have a problem with a coach or coaching
philosophy I will discuss it with the coach calmly and
in private at a non-game time. If I have an on-going
concern I will take it to the board at a club meeting.
• I will refrain from coaching, giving guidance, or
speaking directly to my child while they are on the
field whether it is during practice or a game.
____________________________________
Parent Signature
____________________________________
Player Signature
_______________________________________________________________________________________________________
Please indicate that you have read and understand the above codes of conducts by signing above and returning form to your
coach. Please be aware no player will be permitted to participate in a game without returning a Code of Conduct signed by
both player and parent.
______________________________________________________________________________
Galesville Area Summer Rec.
Athlete Medical Release
Note: to be carried by coaches at all games and practices.
Athlete: __________________________________
Date of Birth: ________________
Parent/Guardian Name(s): __________________________________________________
Phone(s): _____________________
_____________________ __________________
Address: ________________________________________________________________
Family Physician: ________________________________ Phone: __________________
Hospital Preference: _______________________________________________________
In case of emergency contact:
________________________________________________________________________
Name
Phone
Relationship to athlete
________________________________________________________________________
Name
Phone
Relationship to athlete
Please list any allergies or medical problems:
Medical Diagnosis
Medication
Dosage
Frequency of
Dosage
Date of last Tetanus immunization: ___________________________________________
Parent/Guardian Authorization:
In case of emergency, if I am not present, I hereby authorize my child, ______________,
to be treated by Certified Emergency Personnel. (i.e. EMT, First Responders, E.R,
Physician)
__________________________________________________
Signature of Parent/Guardian
__________________
Date